Abstract: INTRODUCTION: The natural history of ocular lesions Behcet’s Disease (BD) is gradual progressions of lesions toward severe loss of vision or blindness. The association of cytotoxic drugs and steroids has dramatically changed the outcome. However, some authors still believe that the improvement is temporary and in the long run (10 years) the eyes progress toward blindness no matter what treatment was applied. The aim of this study was to address this issue by evaluating the visual acuity (VA) in patients with more than 10 years of ocular manifestations. The outcome was then compared with patients having eye lesions for less than 5 years.
MATERIALS AND METHODS: From our database all patients having posterior uveitis and/or retinitis, and having received cytotoxic drugs (cyclophosphamide, methotrexate, chlorambucil, azathioprine, cyclosporine A) were selected. They were divided upon the duration of their eye lesions to 3 groups. Group 1: Less than 5 years from the onset of their eye lesions. Group 2: Between 5 and 10 years. Group 3: More than 10 years. VA of the first and the last visit were compared in each group by the Student paired t test. Then the 3 groups were compared to each other to find if the duration of the disease had any effect on the outcome of the VA.
RESULTS: Data from 959 patients were included in the study, 244 of them had received more than one cytotoxic drug. Group 1 comprised 648 patients. The mean duration of the eye disease (MDED) was 32.2 months. The mean VA improved from 4 to 5 (t=9.665, p<0.0001), 71% of the eyes were improved or stabilized while 29% were aggravated, the confidence interval (CI) was 2.8. Group 2 comprised 182 patients. The MDED was 84.2 months, the mean VA improved from 3.5 to 4.1 (t=3.405, p<0.001), 69% of the eyes were improved or stabilized while 31% were aggravated (CI=5.1). Group 3 comprised 68 patients. The MDED was 165.6 months, the mean VA improved from 3 to 3.9 (t=1.568, p=0.12), 69% of the eyes were improved or stabilized while 31% were aggravated (CI=8.4)
CONCLUSION: Visual acuity aggravated in approximately 1/3 of the eyes regardless of the duration of the disease. However, longer duration of the disease caused a lower VA at baseline and subsequently at the end of the study, while the mean improvement was the same for all groups. Therefore, the majority of eyes do not progress toward blindness, even in long run, if appropriately treated.